title: Effects of switching acute treatment on disability in migraine patients using triptans.
abstract: OBJECTIVE
  To assess the influence of switching acute treatment on headache-related disability in a population sample of individuals with migraine using acute triptan therapy.
  
  
  BACKGROUND
  Acute treatments for migraine are often modified in clinical practice. The effect of changes in treatment from one triptan to another or from a triptan to another medication class has rarely been studied.
  
  
  METHODS
  Patterns of acute treatment for migraine were monitored from 1 year to the next in the American Migraine Prevalence and Prevention (AMPP) Study for the following couplets (2005-2006, 2006-2007, 2007-2008, and 2008-2009). Changes in medication regimens were classified as follows: (1) switch within the triptan class; (2) switch to combination analgesics containing opioids or barbiturates; (3) switch to non-steroidal anti-inflammatory drug (NSAID) agents; (4) maintaining current therapy (consistent use, "control"). We assessed change in migraine disability assessment scale score from the first to the second year of a couplet contrasting those with consistent use with those who changed acute treatment. Each individual contributed only 1 couplet to the analysis. Persons who added an acute treatment are considered in a separate manuscript. We modeled change in migraine disability assessment scale score as a function of change in medication regimen with consistent users as the control group.
  
  
  RESULTS
  We identified 81 individuals who switched to another triptan, with a referent of 619 who remained consistent, 31 cases who switched to an opioid or barbiturate with a referent of 666 who remained consistent, and 20 cases who switched to an NSAID with a referent of 667 cases who remained consistent. In cell-mean coded analyses of covariance (ANCOVA), switching from one triptan to another or switching from a triptan to an opioid/barbiturate was never associated with significant improvements in headache-related disability compared with consistent treatment. Switching from a triptan to an NSAID was associated with significant increases in headache-related disability among those with high-frequency episodic/chronic migraine (HFEM/CM) compared with those with low-frequency episodic migraine (LFEM) (interaction = 34.81, 95% confidence interval 10.61 to 59.00). The same was true comparing high-frequency episodic/chronic migraine with those with moderate-frequency episodic migraine (interaction = 48.73, 95% confidence interval 2.63 to 94.83).
  
  
  CONCLUSIONS
  In this observational study, switching triptan regimens does not appear to be associated with improvements in headache-related disability and in some cases is associated with increased headache-related disability.
authors.affiliation: Vedanta Research, Chapel Hill, NC, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Serrano
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
authors.forename: Shashi H
authors.initials: SH
authors.lastname: Kori
authors.forename: Sypridon
authors.initials: S
authors.lastname: Papapetropoulos
authors.forename: Cedric M
authors.initials: CM
authors.lastname: Cunanan
authors.forename: Aubrey N
authors.initials: AN
authors.lastname: Manack
authors.forename: Michael L
authors.initials: ML
authors.lastname: Reed
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D057915:Drug Substitution / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*; D016896:Treatment Outcome; D014363:Tryptamines / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014363:Tryptamines
keywords: acute treatment; barbiturate; headache-related disability; migraine; opioid; triptan